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Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis.

Mihaljevic AL, Müller TC, Kehl V, Friess H, Kleeff J - PLoS ONE (2015)

Bottom Line: A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44-0.97; p = 0.04; I2 = 56%).Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15-0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54-0.92), but this might largely be due to the lower quality of available data for double-ring devices.Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28-0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57-0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24-0.82; p = 0.001; I2 = 72%).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.

ABSTRACT

Importance: Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality.

Objective: To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections.

Evidence review: A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted.

Findings: We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51-0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44-0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15-0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54-0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28-0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57-0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24-0.82; p = 0.001; I2 = 72%).

Conclusions and relevance: Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations.

No MeSH data available.


Related in: MedlinePlus

Exploratory subgroup analysis, CWEP vs. control in different degrees of contamination.A clean surgeries; B clean-contaminated surgeries; C contaminated surgeries; D dirty-infected surgeries.
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pone.0121187.g007: Exploratory subgroup analysis, CWEP vs. control in different degrees of contamination.A clean surgeries; B clean-contaminated surgeries; C contaminated surgeries; D dirty-infected surgeries.

Mentions: Finally, we investigated the effectiveness of CWEPs vs. control in different levels of contamination (clean, clean-contaminated, contaminated, dirty-infected) (Fig 7A–7D). Five RCTs [29,42,46,49,52] including 472 patients reported data in clean operations, five trials [28,42,46,49,50] including 1456 patients in clean-contaminated surgery, four trials [28,46,49,50] with 206 patients in contaminated and the same four trials 94 patients in dirty-infected surgery. These subgroup analyses have to be treated with caution and are exploratory at best as patient and event numbers are small, and the description and definition of contamination grade varied between trials. The meta-analyses were conducted in a fixed-effects model as few trials were included [38]. The pooled risk ratios were 0.54 (95%CI, 0.29–1.03; p = 0.06; I2 = 56%) in clean surgeries (Fig 7A), 0.72 (95%CI, 0.57–0.91; p = 0.005; I2 = 46%) in clean-contaminated cases (Fig 7B), 0.44 (95%CI, 0.28–0.67; p = 0.002; I2 = 23%) in contaminated operations (Fig 7C) and 0.89 (95%CI, 0.60–1.31; p = 0.54; I2 = 60%) in dirty-infected cases (Fig 7D).


Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis.

Mihaljevic AL, Müller TC, Kehl V, Friess H, Kleeff J - PLoS ONE (2015)

Exploratory subgroup analysis, CWEP vs. control in different degrees of contamination.A clean surgeries; B clean-contaminated surgeries; C contaminated surgeries; D dirty-infected surgeries.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4376627&req=5

pone.0121187.g007: Exploratory subgroup analysis, CWEP vs. control in different degrees of contamination.A clean surgeries; B clean-contaminated surgeries; C contaminated surgeries; D dirty-infected surgeries.
Mentions: Finally, we investigated the effectiveness of CWEPs vs. control in different levels of contamination (clean, clean-contaminated, contaminated, dirty-infected) (Fig 7A–7D). Five RCTs [29,42,46,49,52] including 472 patients reported data in clean operations, five trials [28,42,46,49,50] including 1456 patients in clean-contaminated surgery, four trials [28,46,49,50] with 206 patients in contaminated and the same four trials 94 patients in dirty-infected surgery. These subgroup analyses have to be treated with caution and are exploratory at best as patient and event numbers are small, and the description and definition of contamination grade varied between trials. The meta-analyses were conducted in a fixed-effects model as few trials were included [38]. The pooled risk ratios were 0.54 (95%CI, 0.29–1.03; p = 0.06; I2 = 56%) in clean surgeries (Fig 7A), 0.72 (95%CI, 0.57–0.91; p = 0.005; I2 = 46%) in clean-contaminated cases (Fig 7B), 0.44 (95%CI, 0.28–0.67; p = 0.002; I2 = 23%) in contaminated operations (Fig 7C) and 0.89 (95%CI, 0.60–1.31; p = 0.54; I2 = 60%) in dirty-infected cases (Fig 7D).

Bottom Line: A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44-0.97; p = 0.04; I2 = 56%).Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15-0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54-0.92), but this might largely be due to the lower quality of available data for double-ring devices.Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28-0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57-0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24-0.82; p = 0.001; I2 = 72%).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.

ABSTRACT

Importance: Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality.

Objective: To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections.

Evidence review: A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted.

Findings: We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51-0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44-0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15-0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54-0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28-0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57-0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24-0.82; p = 0.001; I2 = 72%).

Conclusions and relevance: Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations.

No MeSH data available.


Related in: MedlinePlus